<!DOCTYPE html>
<html>

<head>
	<meta charset="utf-8" />
	<title></title>
	<meta name="viewport" content="width=device-width, initial-scale=1,maximum-scale=1,user-scalable=no">
	<script src="../../js/jquery-2.1.4.min.js"></script>
	<script src="../../js/common.js"></script>
	<script type="text/javascript" src="../../js/bootstrap-select.min.js"></script>
	<script type="text/javascript" src="index.js"></script>
	<link rel="stylesheet" type="text/css" href="../../css/bootstrap-select.min.css">
	<link rel="stylesheet" type="text/css" href="index.css" />
	<link rel="stylesheet" type="text/css" href="../../css/common.css" />
	<link rel="stylesheet" type="text/css" href="../../css/bootstrap.min.css" />
	<script type="text/javascript" src="../../js/bootstrap.min.js"></script>
</head>

<body>
	<div class="contiler ">
		<div class="header ">
			<div class="nav-bar ">
				<div class="nav-bar-left ">
					<a class="xiaoyuhao ">
						<i class="iconfont icon-xiaoyuhao "></i>
					</a>
				</div>
				<div class="nav-bar-title ">我要报备</div>
				<div class="nav-bar-right ">
				</div>
			</div>
		</div>
		<div class="contentx">
			<div class="item">
				<span>姓名:</span>
				<input type="text " name="name " id="name" value=""></input>
			</div>
			<div class="item">
				<span>电话:</span>
				<input type="text " name="phone" id="phone" value="" maxlength="11" placeholder="必填"></input>
			</div>
			<div class="item">
				<span>备用电话:</span>
				<input type="text " name="standbyPhone" id="standbyPhone" value="" maxlength="11" placeholder="选填"></input>
			</div>
			<div class="item">
				<span>报备留言:</span>
				<textarea class="build-name" rows="5" cols="30" id="words"></textarea>
			</div>
			<div class="item">
				<span>意向楼盘:</span>
				<select name="loupan" id="loupan">
					<option value="">请选择</option>
				</select>
			</div>
			<div class="item ">
				<span>购房意向:</span>
				<select name="goufang" id="goufang">
				</select>
			</div>
			<div class="item ">
				<span for="id_select">置业顾问:</span>
				<select id="id_select" class="selectpicker bla bla bli" multiple data-live-search="true">
				</select>
			</div>
			<div class="lg-sub">
			       <input id="lg-sub-s" type="submit" value="报备" class="lg-sbt">
			</div>
		</div>
</body>

</html>
